We are aware that worldwide there is lack of organs and today we can only achieve the 10% of the global needs in transplantation, even using living donation from liver and kidney because we have only 38.000 cadaveric donors worldwide per year.
What are the solutions? Our proposal is that nations should support by regulating, laws and legislation and the regions must implement the health systems including developing of deceased donation and basically, as shown in other countries like Spain, Iran, Portugal, Italy, France, etc , to have an hospital structure with organ procurement units , is the main factor to develop Deceased Donation. And that is the TOP 5 models in the world, including USA with a different model which is a OPO system.
The Transplant Procurement Model is based in the TPM professional who is a medical specialist in ICU supported by nurses , dedicated 24h/7days to organ donation , could be a single person or a professional team and the main issue is that depends from the hospital medical direction , it is a social responsibility for any hospital to perform that, and those professionals do the clinical activity, they do the research, they do the quality , they do the management to analyze the cost, as well as training or education.
From our point of view there is no single demonstration that by only changing legislation, awareness campaigns, donor registries, driving license or other way of promotion, donation has increased.
We believe that one professional trained by the health system is the same of 2000 citizens aware of organ donation. Thus, the development of programs to professionalized people has shown in many areas in Europe, in Iran, in China in Emirates and worldwide good results: as many professionals trained, more the donation rates increase.
Also new procedures are useful today like the use of Deceased Donors After Circulatory Death (22% Worldwide, 45% Spain and 54 % in Catalonia). That means the use of NRP and Touraco Abdominal Regional Perfusion as well as ex situ organ perfusion machines to assess viability, improve preservation and restore ischemic damage.
Finally, during more than 25 years, we have been implementing this model in Spain and we have achieved the point of self-sufficiency, that means that our waiting list at the end of the year remains stable of the previous years. So, all the patients in the waiting list have the great opportunity to get transplanted.
In addition, for example in Catalonia (region), the 54% of the patients with chronical kidney disease are transplanted and the other in dialysis, and even the 7% of these patients are preventive transplanted before dialysis.
In conclusion the implementation of the TPM professionals inside the hospitals is the key solution to develop deceased donation Worldwide and can be replicable in any country willing to, included Hong Kong.
